Research Article Critique Guidelines

Title
Name
Institution

Cork, L. L. (2014). Nursing Intuition as an Assessment Tool inforPredicting Severity of Injury in Trauma Patients. Journal of Trauma Nursing, 21(5), 244-252.
I. Introduction.
Gut instinct as a skill is a delicate area in the practice of nursing because many are the times the gut instinct will contradict some formal procedures. Some experts on the issue have argued that intuition is not as abstract a concept rather a rational process that develops out of years of experience in dealing with a similar situation and that it relies on the ability to pick out patterns and act on them (Cert & Wilcockson, 1996). However, that is not the purpose of this critique. In 2012, Loral Cork concluded her two-phased research that had been going on for two years, and she concluded that intuition was a necessary tool in nursing practice. Cork’s recommendation was that for effective utilization of this concept, the experienced nurse should be paired with the novice to enable the latter explores the rationale of some of the decisions of some of the intuitive decisions (Cork, 2014). With a sample of 8 charge nurses and 393 medical records in phase I and II, respectively, a correlation was established experience and the use of the gut instinct as an assessment tool. This paper examines Cork’s research to see how applicable the study is to real emergency department situations.
II. The statement of the Problem
The topic is the applicability of nursing intuition.

It is hard to substantiate such an abstract concept in such a practical profession. And this makes the substance of the research a problem. Decision making in the emergency room makes use of both objective and subjective data (Cork. 2014). A split second decision determines whether or not to enact the trauma code, the kind of care the patient will get, and consequently the outcome of that care. Cork investigates the usefulness of intuition of the nurse in these scenarios and seeks to establish how valid it is. The question she asks is, is nursing intuition a dependable assessment tool in determining the seriousness of damage in trauma patients? Inasmuch as this question seeks to establish the soundness of such an abstract concept, how would one measure the validity of the gut instinct? What are the indicators of successful use of intuition in triage? Is it the number of lives saved or the confirmation of the instinct upon further investigation? Did the research attempt to link specific medical files to the nursing officer who received the trauma victim? Is there a culture within the particular hospital of either encouraging intuition over standard regulation or vice versa? At what point does the charge nurse know she is acting on instinct and not standard protocol. These are some of the factors that would affect the results
III. Research Design
The study is a quantitative one conducted at a 135-bed capacity level III trauma center that receives around 200 trauma cases yearly. It is descriptive in nature and cross-sectional in approach. Anonymity in the study is a good tactic, but all descriptive designs face the challenge of getting biased information. A charge nurse is easily drawn into the researcher’s bias when the questionnaire seeks to know the years of service and the times they have acted intuitively. Descriptive studies also allow respondents to give extra information, but the use of a questionnaire does not allow that. Since the respondents rely on memory, how accurate are the findings and would the same results be replicated if the study was to be repeated? Quantitative study designs tend to yield reliable findings, though, a strength for this article. Having in mind that intuition can only be described by the individual this research design was the only feasible one.
IV. The Sample
For the first Phase of the study, 6 charge nurses participated in the study and 393 medical records were sampled in the second Phase. According to Cohen’s power analysis, 419 files were needed for Phase II, yet only a 393 are used, with 33 of those ineligible. This is a huge reduction in files is for such tight research. There are only 8 charge nurses employed by the hospital, and only 6 of them responded to the questionnaire. Therefore, in all counts, this sample does not suffice. Looking at the participating nurses the least experienced has at least 6 years as a registered nurse that raises the question of who is a novice in nursing. What would be the result if the same study was conducted in a level III trauma center?
V. Data Collection
For the first Phase, the principal investigator assisted by the hospital clinical educator sent questionnaires to the individual nurses via departmental mail in order to avoid bias. The good thing about this voluntary and anonymous participation is assured, and non-participation is also protected. In Phase II, data were collected by examining trauma records for two years. The hospital trauma coordinator collected the data, de-identified it, and tabulated. The principal investigator understood the confidentiality of medical records and the findings and assured it. The hospital board gave permission for the study, and unit-level permission was obtained from the ED director. The probability having the contents of the questionnaires getting into the management was zero. Something not captured by the questionnaire, however, was the outcome or later confirmations of the cases which the nurses acted intuitively. There is no ratio of the cases during which they acted by instinct as to when they used rational reasoning.
VI. Limitation of the Study
According to Cork (2014), the size of the sample was not enough for the study to be generalized to include other geographic areas and other conditions outside trauma. A study that obtained data from only 6 nurses and only in a single level III facility while there are so many others that could have been involved does not qualify to be a documented record. Having a sample less than required in Phase II is also self-defeating. Future studies on the same subject should consider sampling other trauma centers, including those of varied levels too. The busier trauma centers, the better still. Even though participation is both voluntary and anonymous, it would be important to encourage varied levels of experience in the data collection, so as to reflect better the relationship between experience and intuition.
VII. Findings
The results of the study indicated that all charge nurses who had been registered for more than 16 years were confident of the ‘gut instinct’ and would often rely on it to activate the trauma code. Also, those who indicated that they ‘sometimes’ relied on the gut instinct were nurses with less than 10 years if emergency department experience. In addition, the level of education did not have a direct correlation with the reliance on the gut instinct. The results are credible. For the Injury Severity Score of less than 25, the results showed a pattern in the ratios of reliance and non-reliance on intuition, but above that they became unpredictable. It was only upon intuitive intervention that 2 of the victims received prompt and appropriate care (Cork, 2014).
The research question was about the validity of intuition as an assessment tool, and the results partly show that it has been, but apart from 3 cases does not show how useful the tool was. In the cases of ISS below 24, the research does not show how the use of the gut instinct succeeded or failed if it did. If there was a case that required intuitive assessment and it was categorized as ‘others’ and failed. As a result, the study does not show. Yes, it is true that intuitive assessment is often successful, but is its usefulness constrained in a certain ISS range? And what happens if it is used outside that ISS range, and how is it validity measured in those ranges? The study does not fully answer the research question. It would be better if there was a comparison between the prognosis of cases assessed by ‘others’ and that assessed by ‘intuition.’ There is no such comparison in this study.
VIII. Summary
Cork (2014) concludes that nursing intuition is a valuable tool to use, and recommends that novice nurses be paired with experienced ones so as to enhance the learning of the rationality of this method of assessment. This also confirms Benner’s theory that education and experience assist in growing this intuitive judgment (Benner 1984). Still, the sample size is too small for the study to be adopted for general practice and expanded research may be necessary to establish this trend as a fact. Further investigation is also necessary to establish of intuition can stand on its own as an assessment tool, or it is just a reflection of a failed trauma code guideline. What would happen if all trauma cases were treated as a priority if there were enough resources to handle each case without the need for triage, would intuition still be a relevant tool? Or is intuition a pure gamble?
Based on the findings, intuition is useful at the individual level since it cannot be taught in a nursing class. The abstractness is the greatest hindrance because it remains something to be encouraged among nurses, but it cannot be formally regulated upon. Besides, it is always not good to assume trauma as nobody knows how deep it may go. With that, a conclusion can be made to the effect that the gut instinct is useful, but should remain an individual affair. Guts do not speak the same language to everyone.
References
Benner, P. (1984). From novice to expert. Menlo Park.
Cert, P. E., & Wilcockson, J. (1996). Intuition and Rational Decision-Making in Professional Thinking: A False Dichotomy? Journal of advanced nursing, 24(4), 667-673.
Cork, L. L. (2014). Nursing Intuition as an Assessment Tool in Predicting Severity of Injury for Trauma Patients. Journal of Trauma Nursing, 21(5), 244-252.
Gobet, F., & Chassy, P. (2008). Towards an alternative to Benner’s theory of expert intuition in nursing: a discussion paper. International journal of nursing studies, 45(1), 129-139.